Centralised referral platform for child and adolescent mental health services: a mixed-methods evaluation of implementation processes and care pathways.

BACKGROUND

Child and adolescent mental health Services (CAMHS) face increasing demand and long waiting times. In 2021, a centralised referral platform (POP) was implemented in a French metropolitan area to manage first requests through information, brief assessment, orientation and rapid consultation when needed.

OBJECTIVES

To evaluate the reach, effectiveness, adoption and maintenance of a centralised referral platform for CAMHS and to explore implementation determinants.

METHOD: We conducted a mixed-methods evaluation using the Reach, Effectiveness, Adoption, Implementation and Maintenance framework and the Consolidated Framework for Implementation Research. Quantitative data came from POP software and hospital records (February 2022–December 2024). Waiting-time analyses covered referrals from February 2022–December 2023 with 1 year follow-up. Qualitative data came from interviews with professionals from POP, CAMHS and partner services.

FINDINGS: POP received 7578 first requests, mainly boys (60%), children aged 6–12 (45%) and from disadvantaged areas (50%). Of 4890 tracked pathways, 38.2% were redirected to community/partner services and 61.8% to CAMHS. Mean waiting time to first CAMHS contact was 103 days (SD=106), rising from 92 to 113 days between 2022 and 2023 (p<0.001). Waits were shorter for urgent cases and younger children (p<0.01), but longer for disadvantaged children (p<0.01) and those later diagnosed with neurodevelopmental disorders (p=0.004). Qualitatively, POP improved access clarity and triage, though waits remained limited by downstream capacity and coordination issues.

CONCLUSIONS

Centralised referral platforms can improve triage but are not a stand-alone solution to waiting times and equity.

CLINICAL IMPLICATION: Such platforms should be embedded within a broader access strategy including rapid consultation, coordinated care pathways, equity monitoring and sufficient downstream capacity.